Diastolic Ventricular Interaction in Heart Failure With Preserved Ejection Fraction

Sathish K. Parasuraman, Brodie L. Loudon, Crystal Lowery, Donnie Cameron, Satnam Singh, Konstantin Schwarz, Nicholas D. Gollop, Amelia Rudd, Fergus McKiddie, Jim J. Phillips, Sanjay K. Prasad, Andrew M. Wilson, Srijita Sen-Chowdhry, Allan Clark, Vassilios S. Vassiliou, Dana K. Dawson, Michael P. Frenneaux (Corresponding Author)

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Abstract

Background Exercise-induced pulmonary hypertension is common in heart failure with preserved ejection fraction ( HF p EF ). We hypothesized that this could result in pericardial constraint and diastolic ventricular interaction in some patients during exercise. Methods and Results Contrast stress echocardiography was performed in 30 HF p EF patients, 17 hypertensive controls, and 17 normotensive controls (healthy). Cardiac volumes, and normalized radius of curvature ( NRC ) of the interventricular septum at end-diastole and end-systole, were measured at rest and peak-exercise, and compared between the groups. The septum was circular at rest in all 3 groups at end-diastole. At peak-exercise, end-systolic NRC increased to 1.47±0.05 ( P<0.001) in HF p EF patients, confirming development of pulmonary hypertension. End-diastolic NRC also increased to 1.54±0.07 ( P<0.001) in HF p EF patients, indicating septal flattening, and this correlated significantly with end-systolic NRC (ρ=0.51, P=0.007). In hypertensive controls and healthy controls, peak-exercise end-systolic NRC increased, but this was significantly less than observed in HF p EF patients ( HF p EF , P=0.02 versus hypertensive controls; P<0.001 versus healthy). There were also small, non-significant increases in end-diastolic NRC in both groups (hypertensive controls, +0.17±0.05, P=0.38; healthy, +0.06±0.03, P=0.93). In HF p EF patients, peak-exercise end-diastolic NRC also negatively correlated ( r=-0.40, P<0.05) with the change in left ventricular end-diastolic volume with exercise (ie, the Frank-Starling mechanism), and a trend was noted towards a negative correlation with change in stroke volume ( r=-0.36, P=0.08). Conclusions Exercise pulmonary hypertension causes substantial diastolic ventricular interaction on exercise in some patients with HF p EF , and this restriction to left ventricular filling by the right ventricle exacerbates the pre-existing impaired Frank-Starling response in these patients.

Original languageEnglish
Article numbere010114
JournalJournal of the American Heart Association
Volume8
Issue number7
Early online date29 Mar 2019
DOIs
Publication statusPublished - 2 Apr 2019

Fingerprint

Heart Failure
Exercise
Pulmonary Hypertension
Starlings
Diastole
Stroke Volume
Stress Echocardiography
Cardiac Volume
Systole
Heart Ventricles
Echocardiography
Control Groups

Keywords

  • diastolic ventricular interaction
  • exercise pulmonary hypertension
  • heart failure
  • Heart failure
  • Exercise pulmonary hypertension
  • Diastolic ventricular interaction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Parasuraman, S. K., Loudon, B. L., Lowery, C., Cameron, D., Singh, S., Schwarz, K., ... Frenneaux, M. P. (2019). Diastolic Ventricular Interaction in Heart Failure With Preserved Ejection Fraction. Journal of the American Heart Association, 8(7), [e010114]. https://doi.org/10.1161/JAHA.118.010114

Diastolic Ventricular Interaction in Heart Failure With Preserved Ejection Fraction. / Parasuraman, Sathish K.; Loudon, Brodie L.; Lowery, Crystal; Cameron, Donnie; Singh, Satnam; Schwarz, Konstantin; Gollop, Nicholas D.; Rudd, Amelia; McKiddie, Fergus; Phillips, Jim J.; Prasad, Sanjay K.; Wilson, Andrew M.; Sen-Chowdhry, Srijita; Clark, Allan; Vassiliou, Vassilios S.; Dawson, Dana K.; Frenneaux, Michael P. (Corresponding Author).

In: Journal of the American Heart Association, Vol. 8, No. 7, e010114, 02.04.2019.

Research output: Contribution to journalArticle

Parasuraman, SK, Loudon, BL, Lowery, C, Cameron, D, Singh, S, Schwarz, K, Gollop, ND, Rudd, A, McKiddie, F, Phillips, JJ, Prasad, SK, Wilson, AM, Sen-Chowdhry, S, Clark, A, Vassiliou, VS, Dawson, DK & Frenneaux, MP 2019, 'Diastolic Ventricular Interaction in Heart Failure With Preserved Ejection Fraction', Journal of the American Heart Association, vol. 8, no. 7, e010114. https://doi.org/10.1161/JAHA.118.010114
Parasuraman, Sathish K. ; Loudon, Brodie L. ; Lowery, Crystal ; Cameron, Donnie ; Singh, Satnam ; Schwarz, Konstantin ; Gollop, Nicholas D. ; Rudd, Amelia ; McKiddie, Fergus ; Phillips, Jim J. ; Prasad, Sanjay K. ; Wilson, Andrew M. ; Sen-Chowdhry, Srijita ; Clark, Allan ; Vassiliou, Vassilios S. ; Dawson, Dana K. ; Frenneaux, Michael P. / Diastolic Ventricular Interaction in Heart Failure With Preserved Ejection Fraction. In: Journal of the American Heart Association. 2019 ; Vol. 8, No. 7.
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abstract = "Background Exercise-induced pulmonary hypertension is common in heart failure with preserved ejection fraction ( HF p EF ). We hypothesized that this could result in pericardial constraint and diastolic ventricular interaction in some patients during exercise. Methods and Results Contrast stress echocardiography was performed in 30 HF p EF patients, 17 hypertensive controls, and 17 normotensive controls (healthy). Cardiac volumes, and normalized radius of curvature ( NRC ) of the interventricular septum at end-diastole and end-systole, were measured at rest and peak-exercise, and compared between the groups. The septum was circular at rest in all 3 groups at end-diastole. At peak-exercise, end-systolic NRC increased to 1.47±0.05 ( P<0.001) in HF p EF patients, confirming development of pulmonary hypertension. End-diastolic NRC also increased to 1.54±0.07 ( P<0.001) in HF p EF patients, indicating septal flattening, and this correlated significantly with end-systolic NRC (ρ=0.51, P=0.007). In hypertensive controls and healthy controls, peak-exercise end-systolic NRC increased, but this was significantly less than observed in HF p EF patients ( HF p EF , P=0.02 versus hypertensive controls; P<0.001 versus healthy). There were also small, non-significant increases in end-diastolic NRC in both groups (hypertensive controls, +0.17±0.05, P=0.38; healthy, +0.06±0.03, P=0.93). In HF p EF patients, peak-exercise end-diastolic NRC also negatively correlated ( r=-0.40, P<0.05) with the change in left ventricular end-diastolic volume with exercise (ie, the Frank-Starling mechanism), and a trend was noted towards a negative correlation with change in stroke volume ( r=-0.36, P=0.08). Conclusions Exercise pulmonary hypertension causes substantial diastolic ventricular interaction on exercise in some patients with HF p EF , and this restriction to left ventricular filling by the right ventricle exacerbates the pre-existing impaired Frank-Starling response in these patients.",
keywords = "diastolic ventricular interaction, exercise pulmonary hypertension, heart failure, Heart failure, Exercise pulmonary hypertension, Diastolic ventricular interaction",
author = "Parasuraman, {Sathish K.} and Loudon, {Brodie L.} and Crystal Lowery and Donnie Cameron and Satnam Singh and Konstantin Schwarz and Gollop, {Nicholas D.} and Amelia Rudd and Fergus McKiddie and Phillips, {Jim J.} and Prasad, {Sanjay K.} and Wilson, {Andrew M.} and Srijita Sen-Chowdhry and Allan Clark and Vassiliou, {Vassilios S.} and Dawson, {Dana K.} and Frenneaux, {Michael P.}",
note = "This work was funded by the British Heart Foundation, project grant reference PG/13/4/29811.",
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TY - JOUR

T1 - Diastolic Ventricular Interaction in Heart Failure With Preserved Ejection Fraction

AU - Parasuraman, Sathish K.

AU - Loudon, Brodie L.

AU - Lowery, Crystal

AU - Cameron, Donnie

AU - Singh, Satnam

AU - Schwarz, Konstantin

AU - Gollop, Nicholas D.

AU - Rudd, Amelia

AU - McKiddie, Fergus

AU - Phillips, Jim J.

AU - Prasad, Sanjay K.

AU - Wilson, Andrew M.

AU - Sen-Chowdhry, Srijita

AU - Clark, Allan

AU - Vassiliou, Vassilios S.

AU - Dawson, Dana K.

AU - Frenneaux, Michael P.

N1 - This work was funded by the British Heart Foundation, project grant reference PG/13/4/29811.

PY - 2019/4/2

Y1 - 2019/4/2

N2 - Background Exercise-induced pulmonary hypertension is common in heart failure with preserved ejection fraction ( HF p EF ). We hypothesized that this could result in pericardial constraint and diastolic ventricular interaction in some patients during exercise. Methods and Results Contrast stress echocardiography was performed in 30 HF p EF patients, 17 hypertensive controls, and 17 normotensive controls (healthy). Cardiac volumes, and normalized radius of curvature ( NRC ) of the interventricular septum at end-diastole and end-systole, were measured at rest and peak-exercise, and compared between the groups. The septum was circular at rest in all 3 groups at end-diastole. At peak-exercise, end-systolic NRC increased to 1.47±0.05 ( P<0.001) in HF p EF patients, confirming development of pulmonary hypertension. End-diastolic NRC also increased to 1.54±0.07 ( P<0.001) in HF p EF patients, indicating septal flattening, and this correlated significantly with end-systolic NRC (ρ=0.51, P=0.007). In hypertensive controls and healthy controls, peak-exercise end-systolic NRC increased, but this was significantly less than observed in HF p EF patients ( HF p EF , P=0.02 versus hypertensive controls; P<0.001 versus healthy). There were also small, non-significant increases in end-diastolic NRC in both groups (hypertensive controls, +0.17±0.05, P=0.38; healthy, +0.06±0.03, P=0.93). In HF p EF patients, peak-exercise end-diastolic NRC also negatively correlated ( r=-0.40, P<0.05) with the change in left ventricular end-diastolic volume with exercise (ie, the Frank-Starling mechanism), and a trend was noted towards a negative correlation with change in stroke volume ( r=-0.36, P=0.08). Conclusions Exercise pulmonary hypertension causes substantial diastolic ventricular interaction on exercise in some patients with HF p EF , and this restriction to left ventricular filling by the right ventricle exacerbates the pre-existing impaired Frank-Starling response in these patients.

AB - Background Exercise-induced pulmonary hypertension is common in heart failure with preserved ejection fraction ( HF p EF ). We hypothesized that this could result in pericardial constraint and diastolic ventricular interaction in some patients during exercise. Methods and Results Contrast stress echocardiography was performed in 30 HF p EF patients, 17 hypertensive controls, and 17 normotensive controls (healthy). Cardiac volumes, and normalized radius of curvature ( NRC ) of the interventricular septum at end-diastole and end-systole, were measured at rest and peak-exercise, and compared between the groups. The septum was circular at rest in all 3 groups at end-diastole. At peak-exercise, end-systolic NRC increased to 1.47±0.05 ( P<0.001) in HF p EF patients, confirming development of pulmonary hypertension. End-diastolic NRC also increased to 1.54±0.07 ( P<0.001) in HF p EF patients, indicating septal flattening, and this correlated significantly with end-systolic NRC (ρ=0.51, P=0.007). In hypertensive controls and healthy controls, peak-exercise end-systolic NRC increased, but this was significantly less than observed in HF p EF patients ( HF p EF , P=0.02 versus hypertensive controls; P<0.001 versus healthy). There were also small, non-significant increases in end-diastolic NRC in both groups (hypertensive controls, +0.17±0.05, P=0.38; healthy, +0.06±0.03, P=0.93). In HF p EF patients, peak-exercise end-diastolic NRC also negatively correlated ( r=-0.40, P<0.05) with the change in left ventricular end-diastolic volume with exercise (ie, the Frank-Starling mechanism), and a trend was noted towards a negative correlation with change in stroke volume ( r=-0.36, P=0.08). Conclusions Exercise pulmonary hypertension causes substantial diastolic ventricular interaction on exercise in some patients with HF p EF , and this restriction to left ventricular filling by the right ventricle exacerbates the pre-existing impaired Frank-Starling response in these patients.

KW - diastolic ventricular interaction

KW - exercise pulmonary hypertension

KW - heart failure

KW - Heart failure

KW - Exercise pulmonary hypertension

KW - Diastolic ventricular interaction

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U2 - 10.1161/JAHA.118.010114

DO - 10.1161/JAHA.118.010114

M3 - Article

VL - 8

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

SN - 2047-9980

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M1 - e010114

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